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From Judith Daar, writing for Virtual Mentor of the American Medical Association:

Family formation through assisted reproductive technologies (ART) accounts for 3 of every 100 children born in the United States today [1-3]. The demographic of ART-conceived children far exceeds the number of parent-child relationships formed through neonatal adoption, offering opportunities for parenthood that would have been elusive a generation ago. While the majority of ART usage involves couples undergoing in vitro fertilization using their own gametes—known as first-party assisted reproduction—a growing percentage of ART use involves third-party collaborators who assist in an individual’s or couple’s reproductive plan. These third party collaborators participate as sperm donors, egg donors, and gestational carriers; they are typically unrelated to the intended parent or parents and receive compensation for providing gametes or gestational services to the sponsoring prospective parent(s). The vast majority of third-party assisted reproduction scenarios proceed without complication or incident, but occasional mishaps do occur and are worthy of analysis [4].

In contrast to natural reproduction which enjoys the privacy and security of a closed two-party relationship, assisted conception is vulnerable to misconduct by the necessary presence of third parties in the reproductive equation. Ideally, all potential conduct attendant to a collaborative reproduction arrangement should be addressed by a written preconception agreement in which all parties participate voluntarily, transparently, and in good faith. In the event such an agreement is absent, deficient, or breached, intended parents, donors, surrogates, and physicians are best served by understanding their duties and the possible conflicts generated by each scenario. In a clinical practice that combines profound intimacy with arm’s-length negotiated transactions, incidents of malfeasance can cause devastating emotional, psychological, physical, and financial harms. I explore these potential harms through three paradigmatic cases—the deceitful donor, the disobedient surrogate, and the divorcing intended parents.